Medicare disease management pilot ending this year

Three years ago, CMS hired eight private disease management firms to set up chronic care improvement programs for beneficiaries. The programs, which reached as many as 150,000 seniors enrolled in Medicare, use trained nurses or health coaches to reach out to patients and make sure they were taking the right self-care steps. The idea was that by doing so, patients would have fewer hospitalizations and less trips to the emergency department, saving Medicare some money. During the run of the project, three of the eight firms actually dropped out, citing cost overruns--which is bad enough--but the worst was yet to come.

CMS now is closing the project down, having concluded that it hasn't lowered claims. The agency will end the pilot in at the end of the year unless the remaining five companies can cut Medicare claims by $600 to $800 per patient per month from now through December. Since that's unlikely, it seems the pilot is doomed, despite the fact that some physicians (and members of Congress [1]) are lobbying to keep it alive for other reasons.

To learn more about the pilot's results:
- read this AMNews piece [2]

Related Articles:
Senators ask CMS to keep disease-management program [1]
Chronic disease becomes major political issue [3]
MN officials focus on chronic disease care [4]
Report: Primary care MDs should manage chronic diseases [5]